Breast Reconstruction

Dr. Deutsch attempts to restore the beauty of the female form and symmetry with the opposite breast following a mastectomy using the procedures best suited for each patient. Options for breast reconstruction include autologous tissue reconstruction (using your own tissue) as well as reconstruction using tissue expansion and implants.

Flap Reconstruction

Breast reconstruction plastic surgery using autologous tissue (your own tissue) offers many advantages over an implant. The new breast has a realistic form, remains soft and is generally without complication over a lifetime whereas implants have an average lifespan of ten years, may rupture and may cause encapsulation (loss of soft natural contour from scar tissue which may be unattractive and even painful).

DIEP Flap

Dr. Deutsch is one of the only surgeons in Atlanta who performs the DIEP Flap procedure for breast reconstruction. The Deep Inferior Epigastric Perforator (DIEP) Flap was developed in 1994 by Dr. Robert Allen and is basically a free TRAM Flap without the muscle. It utilizes the excess abdominal skin and fat that is usually discarded after a tummy tuck operation and is supplied by a perforator from the same vessels that supply the free TRAM Flap. Like the free TRAM Flap, it is re-attached to an artery and vein in the breast region. By preserving the abdominal muscle and the surrounding fascia, DIEP Flap patients have better abdominal wall strength, less pain and fewer incidences of bulge or hernia. Dr. Deutsch attempts to perform the DIEP Flap on every breast reconstruction patient if they are interested and they are a suitable candidate.

Latissimus Flap

The latissimus flap is a pedicle flap that utilizes the skin, fatty tissue and latissimus muscle from the upper back to the chest to reconstruct the breast. The procedure can correct the defects left by partial breast removal, total mastectomies or from chest wall deformities such as Poland’s syndrome. Patients who desire autologous reconstruction but are not candidates for a TRAM or DIEP are ideal candidates. The flap may be combined with a tissue expander to allow for a larger volume breast upon completion. The flap is released through a crescent shaped skin paddle and rotated around to fill the defect.Hospitalization is 2-3 days. Patients are given a combination of pain relievers, muscle relaxants, antibiotics and a detailed instruction sheet on discharge. Office visits take place one week following hospital discharge and again at 6 weeks following surgery. Full recovery time is 6 weeks. Patients are to avoid heavy lifting and strenuous activity during this time. Scars continue to fade and improve up to a year after surgery. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing or infection.

TRAM (Transverse Rectus Myocutaneous) Flap Reconstruction

TRAM flap reconstruction allows the patient to use excess tissue from the abdomen to reconstruct the breast or breasts. The fat and skin overlying the rectus muscle is carried to correct the defect left following a mastectomy. Ideal candidates are healthy, have adequate abdominal tissue and have realistic expectations of the outcomes. A hip to hip incision is made to elevate the flap like someone undergoing a tummy tuck however this tissue is utilized and not discarded. The remaining soft tissue above the harvested flap is released and the incision is reapproximated. The umbilicus or belly button is preserved and is brought back out to the surface and stabilized. In a Pedicle TRAM (Transverse Rectus Myocutaneous), the blood vessels supplying the tissue are left intact and the entire abdominal flap is tunneled into the pocket left by the mastectomy and reshaped to form a new breast. Pedicle flaps are an ideal option for patients who have had radiation damage or some other type of problem with the vessels used for reanastomosis for a Free TRAM. A Free TRAM requires micro vascular reanastomosis (reattaching of blood vessels under the microscope) of the vessels from the abdominal flap to a blood supply in the chest (usually the internal mammary vessels along the sternum of the thoracodorsal vessels in the axilla).

Advantages of the free TRAM verses a pedicle TRAM are decreased risk of abdominal hernia or bulge and a lower incidence of fat necrosis. Success rates for the free TRAM are 97-98%.Complications related to TRAM flaps are low but include the following: total or partial flap loss, fat necrosis (hard areas in flap due to poor fat healing), inadequate abdominal wound healing, hernia, abdominal bulge, infection and hematoma (blood accumulation).Patients generally stay 3-5 days in the hospital following the plastic surgery procedure. Patients are given a combination of pain relievers, muscle relaxants, antibiotics and a detailed instruction sheet on discharge. Office visits take place one week following hospital discharge and again at 6 weeks following surgery. Full recovery is 6 weeks. Patients are to avoid heavy lifting and strenuous activity during this time. Scars continue to fade and improve up to a year after surgery. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing or infection

54 y/o female had Stage 1 left breast cancer. She wore a 36DD bra and wanted to use her abdominal tissue for breast reconstruction. She underwent left modified radical mastectomy and muscle sparing free TRAM flap reconstruction. Her postop picture is following nipple reconstruction and tattoo 1 year after surgery.

Front Before

Left Before

Right Before

Front After

Left After

Right After

Tissue Expanders and Implants

Breast reconstruction with a tissue expander which is later exchanged for an implant (saline or silicone) utilizes prosthetic materials to correct the mastectomy defect. The expander can be placed at the time of mastectomy or later. It is inserted under the pectoralis muscle and then slowly expanded in the office to stretch the overlying tissue and make room for a “permanent” implant. Expansion is done on a weekly basis until the desired size is achieved. The technique is tolerated relatively well, requires a short operating time and reduced recovery time and provides good aesthetic results. It is a great option for patients who do not meet protocol for autologous reconstruction. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing or infection. Disadvantages include implant rupture, rippling (ability to see/feel edges of implant), need for multiple procedures and prolonged reconstruction, and poor results in radiated patients.

The photographs are of patients of Dr. Deutsch’s. These patients have agreed to be a part of this website strictly as an informative tool. The pictures are meant to provide an idea of surgical outcomes. Please remember that each patient’s results are individual and unique to body form. In addition, any surgical procedure elicits scars. The degree of scar formation is also on an individual basis. Scars do improve with time and with appropriate massage and protection from the sun. Dr. Deutsch can also improve scar appearance through injections and/or surgical revision.